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Published from February 28, 2013 to December 1, 2015

Innovative Neurosurgery

ISSN: 2193-5238

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This journal has ceased publication.

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Topics

Volume 3 Issue 3-4

December 2015

Publicly Available November 28, 2015

Frontmatter

Page range: i-iii

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Reviews

November 17, 2015

Comparative effectiveness and safety of 3D versus 2D endoscopy in skull base surgery: a systematic review

Hani J. Marcus, Yizhou Wan, Nils H. Ulrich, Robert Reisch

Page range: 53-58

Abstract

Background: The recent introduction of 3-dimensional (3D) endoscopes may improve depth perception, but this must be balanced against their higher cost, larger size, and greater weight. Methods: The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed databases were searched between January 1990 and December 2014. Titles and abstracts were screened to identify publications that (1) featured adult patients, (2) compared 2D and 3D endoscopy, and (3) reported on effectiveness or safety. Results: A total of 163 articles were pooled from the electronic databases. After exclusion, six articles were identified that satisfied the inclusion criteria, comprising three preclinical studies, two retrospective cohort studies, and one case-control study. In the clinical studies a total of 244 patients undergoing endoscopic pituitary surgery were reported – 140 (57.4%) with 2D HD endoscopes, and 104 (42.6%) with 3D SD endoscopes. There was no significant difference in the extent of resection, operating time, or complications, between the 2D and 3D groups. Conclusion: Larger prospective clinical studies comparing 3D and 2D are warranted to determine the extent to which subjective improvements in perception lead to objective improvements in patient outcome.

November 21, 2015

Flow diverters for intracranial aneurysms

Alice Venier, Beatrice Gardenghi, Giuseppe Lanzino, Stylianos K. Rammos

Page range: 59-65

Abstract

The progressive establishment of endovascular management in treating intracranial aneurysms had lead to continuous technique advancements and development of innovative technologies. Flow diverters are “stent-like” devices currently used for complex unruptured aneurysms allowing endoluminal reconstruction of the parent artery and occlusion of the aneurysm sac. In the present article, we review the development of flow diversion devices through in vitro and in vivo studies to clinical practice and summarize recent clinical data.

Original Research Articles

November 28, 2015

Does the routine use of intraoperative MRI prolong progression free survival in low-grade glioma surgery? A retrospective study

Andrej Pala, Ralph König, Michal Hlavac, Christian Rainer Wirtz, Jan Coburger

Page range: 67-74

Abstract

Introduction: Available data imply that extent of resection (EOR) improves progression free survival (PFS) in patients harboring a low-grade glioma (LGG). Intraoperative high-field magnetic resonance imaging (iMRI) is an established diagnostic tool that can detect residual tumors in LGG surgery. We conducted a retrospective study to evaluate the extent of resection, clinical outcome and PFS in conventional and iMRI-based LGG resection. Patients and methods: A total of 69 patients was assessed. Only World Health Organization (WHO) grade II LGGs were evaluated. Thirty-three patients had surgery using iMRI (2008–2013). Thirty-six patients underwent surgery before introduction of iMRI at our center (2000–2008). Demographic data, extent of resection (EOR), complication rate, overall time of surgery and progression free survival were evaluated. Results: The majority of patients were treated for a diffuse astrocytoma in both cohorts (iMRI: 46.9%, historical (hist.): 61.1%). Extent of resection was a positive prognostic factor for longer PFS according to Cox regression multivariate analysis controlled by eloquent location, tumor recurrence and histological subtype [P<0.001, hazard ratio (HR) 0.247]. Additionally, the Cox regression showed the advantage and longer PFS of iMRI-assisted resections using the same settings (P=0.038, HR=0.378). Permanent neurological deficits (PND) after surgery were found in 12.5% (n=4) of the iMRI group and in 22.2% (n=8) of the historical group. Duration of surgery was significantly higher in the iMRI group (iMRI: 6.3 h, hist.: 4.3 h, P<0.036). However, there was no significant increase of postoperative surgical complications. Gross total resection (GTR) was achieved in 63.6% (n=21) of iMRI patients and 27.8% (n=10, P<0.0069) in the historical control, respectively. Binary logistic regression showed that iMRI has a significant impact on tumor remnants (P<0.001). Conclusion: In our study we have confirmed EOR to be an important positive prognostic factor for PFS. At our center, compared to a historical group, the routine use of iMRI increases EOR and was associated with a decrease in complications. Due to a selection bias no final conclusion can be drawn as to whether the use of iMRI increases PFS.

August 26, 2015

Endoscope-integrated indocyanine green video-angiography for cerebral aneurysm surgery: a more effective technique

Ittichai Sakarunchai, Yoko Kato, Yasuhiro Yamada, Thomas Tommy

Page range: 75-79

Abstract

Introduction: Microscope-integrated indocyanine green video-angiography (mICG-VA) is used as an adjunct to aneurysm surgery in checking for small compromised perforating arteries and the remnant of an aneurysmal neck. A limitation of mICG-VA is the inability to access the deep area where small vessels are located behind the aneurysm sac or the parent artery. The endoscope-integrated ICG-VA (eICG-VA) is not only a tool in obtaining a wide angle of surgical view, but also is a technique to detect real-time blood flow during aneurysm clipping. Methods: Patients with an unruptured cerebral aneurysm who had conventional endoscope-assisted microsurgery and eICG-VA were enrolled. We compared the efficacy and additional details of imaging from both types of procedures. Results: The data of seven patients were reviewed. In two cases of small perforating arteries that were hidden by the aneurysm sacs, more details were detected by eICG-VA. While the performance of the conventional technique was limited, the eICG-VA revealed a wide view in the deep area during aneurysm clipping. Conclusion: The eICG-VA provides more details of the aneurysm, especially in small perforating vessels that were hidden by the aneurysm. It can resolve the limitations of the conventional endoscope and mICG-VA.

November 28, 2015

Intraventricular injectable tumor model for neuroendoscopic surgery: Laboratory Study

Anthony M.T. Chau, Filippo Gagliardi, Pietro Mortini, Samer K. Elbabaa, Cristian Gragnaniello

Page range: 81-85

Abstract

Intraventricular tumors present difficult challenges to the neurosurgeon. Neurosurgeons have begun to explore the possibilities of the endoscope in the complete resection of solid intraventricular tumors. The learning curve is considered steep when dealing with such lesions endoscopically. The aim of this study was to develop a laboratory training model for pathological intraventricular neuroendoscopic surgery. Thirty formalin-fixated, latex-injected cadaveric heads were used. The contrast-enhancing tumor polymer, Stratathane resin ST-504 derived polymer (SRSDP), was injected into the lateral ventricle via Frazer’s point under direct endoscopic visualization and real-time fluoroscopic guidance. Neurosurgeon participants at a ventricular endoscopic course then performed an endoscopic approach to the intraventricular tumor model lesion via an ipsilateral frontal burr hole. The properties of the SRSDP mixture could be manipulated through varying concentrations of source materials in order to achieve a desired consistency and allow for piecemeal resection. Tumor could be injected into the lateral and third ventricles. The tumor model allowed participants to compare both normal and pathological endoscopic anatomy in the one specimen. Our novel injectable tumor model can assist neurosurgeons preparing themselves for the challenges associated with a piecemeal resection of a solid lesion in the lateral or third ventricle.

Case Report

November 5, 2015

Middle meningeal arteries with and without transdural anastomosis in Moyamoya disease can be distinguished using intraoperative Doppler sonography

Kimitoshi Sato, Toshihiro Kumabe

Page range: 87-90

Abstract

Transdural anastomosis (TA) from the middle meningeal arteries (MMAs) to the brain is important in maintaining cerebral blood flow in patients with Moyamoya disease. A 16-year-old adolescent girl presented with a transient ischemic attack. Preoperative cerebral angiography revealed TA from the MMA. During surgery, the MMA was exposed on the dural surface directly under the burr hole. Measurement of flow velocity in the MMA with an ultrasonic blood flowmeter revealed increased diastolic flow velocity. As the MMA was assumed to contribute to TA, a new burr hole was made to preserve the MMA, and a bone flap was prepared. Direct and indirect bypass surgeries were performed. Electrocoagulation was not applied to the MMA associated with TA, but the artery was compressed with gelfoam containing fibrin glue to achieve hemostasis. Postoperatively, no evidence of cerebral infarction was detected. Determining which of several MMAs exposed in the surgical field is associated with TA can be difficult. However, measurement of flow velocity with an ultrasonic blood flowmeter to confirm increased flow velocity in the diastolic phase is useful for confirming the presence or absence of TA from the extracranial arteries including the MMA.

Book Review

November 28, 2015

Principles and Practice of Keyhole Brain Surgery

Anne-Katrin Hickmann

Page range: 91-91

November 28, 2015

Issue 1-4

Volume 1 (2013)

No ranking information is available for this journal.

(Deutsch)

Online ISSN: 2193-5238
Type: Journal
Language: English
Publisher: De Gruyter
First published: February 28, 2013
Last published: December 1, 2015
Publication Frequency: 4 Issues per Year

Innovative Neurosurgery

Frontmatter

Comparative effectiveness and safety of 3D versus 2D endoscopy in skull base surgery: a systematic review

Abstract

Flow diverters for intracranial aneurysms

Abstract

Does the routine use of intraoperative MRI prolong progression free survival in low-grade glioma surgery? A retrospective study

Abstract

Endoscope-integrated indocyanine green video-angiography for cerebral aneurysm surgery: a more effective technique

Abstract

Intraventricular injectable tumor model for neuroendoscopic surgery: Laboratory Study

Abstract

Middle meningeal arteries with and without transdural anastomosis in Moyamoya disease can be distinguished using intraoperative Doppler sonography

Abstract

Principles and Practice of Keyhole Brain Surgery

Acknowledgment to our reviewers

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